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General NPI Number Information
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NPI Number | 1952571101
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Entity Type | Organization
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Legal Business Name | MIKALA A LEGAKO PSYD PSYCH SVC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 08/02/2020
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Provider Practice Location Address
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Address Line | 83 BAILEY DR
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City | NEWNAN
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State | GA
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Zip | 30263-2913
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Country | US
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Telephone | 678-314-7469
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Fax |
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Provider Business Mailing Address
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Address Line | 83 BAILEY DR
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City | NEWNAN
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State | GA
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Zip | 30263-2913
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Country | US
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Telephone | 678-314-7469
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | MIKALA ANNE LEGAKO
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Credential | PSYD
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Telephone | 678-314-7469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 002428
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License Number State | GA
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